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Individual
BLAINE RANDALL BLAKESTAD
Active
Individual
BLAINE RANDALL BLAKESTAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
F1391
TX
208D00000X
General Practice Physician
Primary
F1391
TX
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
F1391
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
214434701
—
TX
01
—
8F6127
BLUE CROSS
TX
Enumeration date
05/27/2006
Last updated
09/29/2020
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